Anaphylaxis and clinical utility of real-world measurement of Acute Serum Tryptase in UK emergency departments

Richard Buka, Rebecca C Knibb, Richard Crossman, Cathryn Melchior, Aarnoud Huissoon, Scott Hackett, Susan Dorrian, Matthew Cooke, Mamidipudi Krishna

Research output: Contribution to journalArticle

Abstract

Background: British guidelines recommend that serial acute serum tryptase measurements be checked in all adults and a subset of children presenting with anaphylaxis. This is the first study reporting the clinical utility of acute serum tryptase in a “real-world” emergency department (ED) setting following the publication of the World Allergy Organization (WAO) criteria for anaphylaxis.
Objectives: To (1) assess sensitivity, specificity, and positive and negative predictive values (PPV, NPV) of acute serum tryptase in anaphylaxis; (b) determine factors associated with higher acute serum tryptase levels; and (c) audit compliance of acute serum tryptase measurement in the ED.
Methods: The methods used were retrospective electronic search for ED admissions to 3 acute care hospitals in Birmingham, UK, with anaphylaxis in 2012 using wide search terms followed by scrutiny of electronic clinical records and application of the WAO diagnostic criteria for anaphylaxis. Patients with an acute serum tryptase measurement were included in the analysis.
Results: Acute serum tryptase level was measured in 141 of 426 (33.1%) cases. Mean time from the onset of symptoms to the measurement of acute serum tryptase level was 4 hours 42 minutes (SD ± 05:03 hours) and no patients had serial measurements conforming to British guidelines. Acute serum tryptase level of more than 12.4 ng/mL (75th centile) was associated with a sensitivity, specificity, PPV, and NPV of 28%, 88%, 0.93, and 0.17, respectively. Multiple regression analysis showed that male sex (odds ratio, 2.66; P = .003) and hypotension (odds ratio, 7.08; P = .001) predicted higher acute serum tryptase level.
Conclusions: An acute serum tryptase level of more than 12.4 ng/mL in an ED setting carries high PPV and specificity, but poor sensitivity and NPV.
LanguageEnglish
Pages1280-87
JournalJournal of Allergy and Clinical Immunology: In Practice
Volume5
Issue number5
DOIs
Publication statusPublished - 6 Sep 2017

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Tryptases
Anaphylaxis
Hospital Emergency Service
Serum
Sensitivity and Specificity
Odds Ratio
Guidelines
Sex Ratio
Hypotension
Compliance
Publications
Hypersensitivity
Regression Analysis
Organizations

Bibliographical note

© 2017, Elsevier. Licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International
http://creativecommons.org/licenses/by-nc-nd/4.0/.

Keywords

  • Anaphylaxis
  • Emergency department
  • Hypotension
  • Tryptase
  • ROC curve

Cite this

Buka, Richard ; Knibb, Rebecca C ; Crossman, Richard ; Melchior, Cathryn ; Huissoon, Aarnoud ; Hackett, Scott ; Dorrian, Susan ; Cooke, Matthew ; Krishna, Mamidipudi. / Anaphylaxis and clinical utility of real-world measurement of Acute Serum Tryptase in UK emergency departments. 2017 ; Vol. 5, No. 5. pp. 1280-87.
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abstract = "Background: British guidelines recommend that serial acute serum tryptase measurements be checked in all adults and a subset of children presenting with anaphylaxis. This is the first study reporting the clinical utility of acute serum tryptase in a “real-world” emergency department (ED) setting following the publication of the World Allergy Organization (WAO) criteria for anaphylaxis.Objectives: To (1) assess sensitivity, specificity, and positive and negative predictive values (PPV, NPV) of acute serum tryptase in anaphylaxis; (b) determine factors associated with higher acute serum tryptase levels; and (c) audit compliance of acute serum tryptase measurement in the ED.Methods: The methods used were retrospective electronic search for ED admissions to 3 acute care hospitals in Birmingham, UK, with anaphylaxis in 2012 using wide search terms followed by scrutiny of electronic clinical records and application of the WAO diagnostic criteria for anaphylaxis. Patients with an acute serum tryptase measurement were included in the analysis.Results: Acute serum tryptase level was measured in 141 of 426 (33.1{\%}) cases. Mean time from the onset of symptoms to the measurement of acute serum tryptase level was 4 hours 42 minutes (SD ± 05:03 hours) and no patients had serial measurements conforming to British guidelines. Acute serum tryptase level of more than 12.4 ng/mL (75th centile) was associated with a sensitivity, specificity, PPV, and NPV of 28{\%}, 88{\%}, 0.93, and 0.17, respectively. Multiple regression analysis showed that male sex (odds ratio, 2.66; P = .003) and hypotension (odds ratio, 7.08; P = .001) predicted higher acute serum tryptase level.Conclusions: An acute serum tryptase level of more than 12.4 ng/mL in an ED setting carries high PPV and specificity, but poor sensitivity and NPV.",
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Buka, R, Knibb, RC, Crossman, R, Melchior, C, Huissoon, A, Hackett, S, Dorrian, S, Cooke, M & Krishna, M 2017, 'Anaphylaxis and clinical utility of real-world measurement of Acute Serum Tryptase in UK emergency departments' vol. 5, no. 5, pp. 1280-87. https://doi.org/10.1016/j.jaip.2017.06.021

Anaphylaxis and clinical utility of real-world measurement of Acute Serum Tryptase in UK emergency departments. / Buka, Richard; Knibb, Rebecca C; Crossman, Richard; Melchior, Cathryn; Huissoon, Aarnoud; Hackett, Scott; Dorrian, Susan; Cooke, Matthew; Krishna, Mamidipudi.

Vol. 5, No. 5, 06.09.2017, p. 1280-87.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Anaphylaxis and clinical utility of real-world measurement of Acute Serum Tryptase in UK emergency departments

AU - Buka, Richard

AU - Knibb, Rebecca C

AU - Crossman, Richard

AU - Melchior, Cathryn

AU - Huissoon, Aarnoud

AU - Hackett, Scott

AU - Dorrian, Susan

AU - Cooke, Matthew

AU - Krishna, Mamidipudi

N1 - © 2017, Elsevier. Licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International http://creativecommons.org/licenses/by-nc-nd/4.0/.

PY - 2017/9/6

Y1 - 2017/9/6

N2 - Background: British guidelines recommend that serial acute serum tryptase measurements be checked in all adults and a subset of children presenting with anaphylaxis. This is the first study reporting the clinical utility of acute serum tryptase in a “real-world” emergency department (ED) setting following the publication of the World Allergy Organization (WAO) criteria for anaphylaxis.Objectives: To (1) assess sensitivity, specificity, and positive and negative predictive values (PPV, NPV) of acute serum tryptase in anaphylaxis; (b) determine factors associated with higher acute serum tryptase levels; and (c) audit compliance of acute serum tryptase measurement in the ED.Methods: The methods used were retrospective electronic search for ED admissions to 3 acute care hospitals in Birmingham, UK, with anaphylaxis in 2012 using wide search terms followed by scrutiny of electronic clinical records and application of the WAO diagnostic criteria for anaphylaxis. Patients with an acute serum tryptase measurement were included in the analysis.Results: Acute serum tryptase level was measured in 141 of 426 (33.1%) cases. Mean time from the onset of symptoms to the measurement of acute serum tryptase level was 4 hours 42 minutes (SD ± 05:03 hours) and no patients had serial measurements conforming to British guidelines. Acute serum tryptase level of more than 12.4 ng/mL (75th centile) was associated with a sensitivity, specificity, PPV, and NPV of 28%, 88%, 0.93, and 0.17, respectively. Multiple regression analysis showed that male sex (odds ratio, 2.66; P = .003) and hypotension (odds ratio, 7.08; P = .001) predicted higher acute serum tryptase level.Conclusions: An acute serum tryptase level of more than 12.4 ng/mL in an ED setting carries high PPV and specificity, but poor sensitivity and NPV.

AB - Background: British guidelines recommend that serial acute serum tryptase measurements be checked in all adults and a subset of children presenting with anaphylaxis. This is the first study reporting the clinical utility of acute serum tryptase in a “real-world” emergency department (ED) setting following the publication of the World Allergy Organization (WAO) criteria for anaphylaxis.Objectives: To (1) assess sensitivity, specificity, and positive and negative predictive values (PPV, NPV) of acute serum tryptase in anaphylaxis; (b) determine factors associated with higher acute serum tryptase levels; and (c) audit compliance of acute serum tryptase measurement in the ED.Methods: The methods used were retrospective electronic search for ED admissions to 3 acute care hospitals in Birmingham, UK, with anaphylaxis in 2012 using wide search terms followed by scrutiny of electronic clinical records and application of the WAO diagnostic criteria for anaphylaxis. Patients with an acute serum tryptase measurement were included in the analysis.Results: Acute serum tryptase level was measured in 141 of 426 (33.1%) cases. Mean time from the onset of symptoms to the measurement of acute serum tryptase level was 4 hours 42 minutes (SD ± 05:03 hours) and no patients had serial measurements conforming to British guidelines. Acute serum tryptase level of more than 12.4 ng/mL (75th centile) was associated with a sensitivity, specificity, PPV, and NPV of 28%, 88%, 0.93, and 0.17, respectively. Multiple regression analysis showed that male sex (odds ratio, 2.66; P = .003) and hypotension (odds ratio, 7.08; P = .001) predicted higher acute serum tryptase level.Conclusions: An acute serum tryptase level of more than 12.4 ng/mL in an ED setting carries high PPV and specificity, but poor sensitivity and NPV.

KW - Anaphylaxis

KW - Emergency department

KW - Hypotension

KW - Tryptase

KW - ROC curve

U2 - 10.1016/j.jaip.2017.06.021

DO - 10.1016/j.jaip.2017.06.021

M3 - Article

VL - 5

SP - 1280

EP - 1287

IS - 5

ER -